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- 1. Employment Application Form Please affix your passport size photo here Please read the below instructions carefully before you start filling in the requested information: 1) Please read all instructions for each section and fill in as instructed. All fields are to be filled legibly, completely and accurately in CAPITAL letters to reduce delay in processing your candidature with IBM. 2) Please bring the following documents with you to the personal interview at IBM: i) Completed IBM Employment Application Form ii) Proof of Salary Documents Offer letter with compensation break up OR Latest increment letter from present organization with compensation break-up iii) Updated Resume iv) Valid Photo ID (Passport, PAN Card, Voters ID card, Drivers License) Past IBM Interview Details (Fill in CAPITAL Letters) Have you attended any IBM Interview in the last 3 Months Yes No If Yes, please provide the below details: D D M M M Y Y Y Y Date of Interview Position Applied ### Work in Progress Received Offer Rejected/Declined Location Of Interview ### IBM subsidiary Name IBM India Pvt Ltd IBM Daksh IBM NetSol Page 1 of 6, Employment Application form, version 1.7, wef - 21th July 2010 1
- 2. SOURCE INFORMATION (Fill in CAPITAL Letters) How did you know about this vacancy in IBM? (Select any one of the below) Direct - IBM Website Y ALP CONSULTING Agency LTD IBM Employee Referral Accepted Not Joined Candidate Agency name A L P Name of the Employee C O N S U L T I N G L T D Employee Number (If Applicable) Jobsites Job Site Name E- Mail ID IBM Application ID * C 8 * If you have already registered on our IBM Job Portal please provide the IBM Candidate Applicant ID also called GOM Candidate Applicant ID. If you are referred by an Agency, please ask your agency for the Applicant ID PERSONAL INFORMATION (Fill in CAPITAL Letters) * Enter your name as per your Passport, Driver's Licence OR PAN Card (For Indian Nationals) Title Mr. Ms. First Name Middle Name Last Name D D M M M Y Y Y Y Date of Birth **e.g. 01 - JAN - 1900 Mobile Number **Country code - Mobile Number Telephone - Per so **Country code - City Code - Telephone Number nal Em ail ID Pan Card (If you are an Indian National) Driver's Licence # Passport Number D D M M M Y Y Y Y Passport Expiry Page 2 of 6, Employment Application form, version 1.7, wef - 21th July 10 2
- 3. PERSONAL INFORMATION CONTINUED (Fill in CAPITAL Letters) Nationality If you are not an Indian National, do you have a valid work permit to be employed in India? Yes No Current Address City PIN Code State Country Permanent Address (If different from the above) City PIN Code State Country PROFESSIONAL REFERENCES (Fill in CAPITAL Letters) Please provide details of three professional references, with whom you have had a business/Working relationship. Please exclude Friends, Colleagues, Juniors and Relatives at work Nature of professional Name Contact Number Current occupation Comments* Relationship *Please use the comments column to indicate if you do not wish IBM to contact one or any of the above for pre-reference checks. Page 3 of 6, Employment Application form, version 1.7, wef - 21th July 10 3
- 4. EDUCATION DETAILS (Fill in CAPITAL Letters) COMPLETED degree programs only. Please complete all fields, even if you have already provided a resume. Provide details on Highest Qualification (Completed)** e.g.: M.Sc, B.Com PLEASE MENTION COMPLETE DETAILS OF SCHOOL / COLLEGE / INSTITUTION AND UNIVERSITY NAME ALONG WITH COMPLETE ADDRESS WITH CITY & POSTAL CODE IN CAPITAL LETTERS Name of the Class/ Degree Qualification Course Tenure Complete Name & Address of School / College / Institution and Division/ Awarded Name of the University Percentage/ (e.g.. B.com / *University name is mandatory where applicable(DO NOT ABBREVIATE) Grade Points BA/ Mtech) M M M Y Y Start Date SSLC End Date * E.g. JAN09 M M M Y Y Start Date HSLC End Date * E.g. JAN09 M M M Y Y Start Date Graduation End Date * E.g. JAN09 University Name M M M Y Y Start Date Post Graduation End Date * E.g. JAN09 University Name M M M Y Y Others - PhD, Start Date Additional Degrees End Date * E.g. JAN09 University Name M M M Y Y Professional Qualification (Other Start Date than already mentioned above) like End Date CA, CFA etc * E.g. JAN09 State reasons for GAP in education, if any : Professional Training (includes in progress degrees) - please mention the details ______________________________________________________________________________________________________________________________________________ Page 4 of 6, Employment Application form, version 1.7, wef - 21th July 10 ### 4
- 5. EMPLOYMENT HISTORY (Fill in CAPITAL Letters) Provide your job history for a minimum of the last five (5) years (if applicable). Additionally, include your last three 3 employers (if applicable) even if your total service exceeds 5 years in the last 1 or 2 companies. Please include information on Self employment within the same period. Do you have prior employment experience? Yes No PLEASE MENTION COMPLETE DETAILS OF ORGANISATION NAME, COMPLETE ADDRESS WITH STREET NAME, AREA, CITY & POSTAL CODE IN CAPITAL LETTERS Employment Type Full Serial Employee Organisation Name and address (Permanent Tenure Time / No Number /Contractual) Part Time Organisation Name D D M M M Y Y Address Start Date 1 End Date Pin Code * E.g. 01-JAN-1900 Organisation Name D D M M M Y Y Address Start Date 2 End Date Pin Code * E.g. 01-JAN-1900 Organisation Name D D M M M Y Y Address Start Date 3 End Date Pin Code * E.g. 01-JAN-1900 Below is continuation of the above table. E.g. Continue to fill in details of "Serial No 1" (Above) in "Serial No 1-Continue" row below. Serial Reporting Manager's Name and Designation Reasons for Leaving If Employment Type is Contractual, Please Provide Agency Name, COMPLETE Address and Contact Number No contact number)* Organisation Name Complete Address 1- Continue Pin Code Contact Number Organisation Name Complete Address 2- Continue Pin Code Contact Number Organisation Name Complete Address 3- Continue Pin Code Contact Number *Current Reporting Manager will be contacted ONLY AFTER the candidate joins IBM Total years of experience - (please do not include any training or internship experience) Years Months State GAP in Employment if any: Page 5 of 6, Employment Application form, version 1.7, wef - 21th July 10 5
- 6. Present Employment Compensation Details** (Fill in CAPITAL Letters) ** The information stated here must be supported with documentary evidence (Offer letter from present organization including Compensation break up details or most recent increment letter) Please mention below your annual compensation details (A). Fixed Pay (B).Variable Pay (C). Other allowances including statutory (Rs.) (Rs.) benefits (Rs.) Annual Current CTC = Total of A + B + C Comments (Rs.) OTHER DETAILS (Fill in CAPITAL Letters) Have you worked for IBM earlier? Yes No If "YES", please provide following details: Tenure (DD-MMM-YYYY) Status Employee No. / Business Unit Location Date of Joining Last working day Manager's Name (Regular/FTH/Contractor) Contractor Code Are you willing to relocate as part of your employment with IBM? Yes No If "YES", please indicate your preference _______________________________________________________________________ If you are related to IBM India Private Limited employees and/or Directors (sibling / spouse/ children/in law relationships), please provide names and relationship. Name Designation Business Unit Relationship Consistent with IBM's policy on workforce diversity and in order to accommodate employee's special needs in the work environment, please indicate if you are physically challenged ** Yes No If yes, please provide description of disability and accommodation required: ** IBM Corporation is an Equal Employment Opportunity Employer Do you have any non-compete obligations or conflict situations or other restrictive clauses with any party including any of your previous employers that prevent you from working for IBM India Private Limited? Yes No Have you worked for the Government, whether as a civilian employee or member of the military? Yes No All Candidates must indicate if they have worked for the Government, whether as a civilian employee or member of the military. If so, you must also indicate whether you had any responsibilities or were involved in activities relating to IBM or an affiliated Company. You must also state whether you are aware of any legal restrictions on what work you may do for IBM or an affiliated Company, and if so, what those restrictions are. _________________________________________________________________________________________________________________________________ _________________________________________________________________________________________________________________________________ Declaration I confirm that the information provided by me in this application form is complete and accurate. I understand that if any information provided by me with respect to my application for employment is found to be untrue, inaccurate or misleading, IBM INDIA Private Limited may withdraw any offer of employment made to me or terminate my employment (If I have already joined IBM India) without notice. I understand that all the details provided in this application are subject to verification. I hereby authorize IBM India Private Limited and its representatives (including reference check agencies/third party vendors) to verify information provided in my application for employment and to conduct enquiries as deemed necessary by the company. I authorize all persons who have information regarding my education, employment, and all other details provided in this form, to disclose it to IBM or its representative. Signature: Place: Date: Page 6 of 6, Employment Application form, version 1.7, wef - 21th July 10 6